Tele-cognitive rehabilitation for adult lower-grade glioma: An interim prospective pilot feasibility study

Cognitive impairments are common in lower-grade gliomas (grades 1-3), but treatment options are limited. Tele-cognitive rehabilitation offers a potential solution. We conducted an interim pilot study to assess the feasibility, satisfaction, and early efficacy of tele-cognitive rehabilitation.

We enrolled adults with stable LrGG (≥6 months posttreatment) who had subjective and objective cognitive impairments (>1 SD below-average in ≥2 domains). Participants received 3 months of individual Goal Management Training (GMT), app-based ReMind, or texting. Cognition and patient-reported outcomes were assessed at baseline (T1), postintervention (T2), and 9 months postbaseline (T3). We assessed enrollment, adherence, and satisfaction. Adherence was defined as ≥80% of participants completing ≥80% of the protocol; satisfaction as ≥6/7 for GMT and texting, and ≥4/5 for ReMind on a self-report Likert question. We used ANOVA, reliable change indices, and qualitative analytics.

Thirty-nine participants were eligible and 33 prospectively enrolled for the study; an 85% enrollment (17-GMT, 8-ReMind, 8-texting; 46.8 median age, 64.8 months from diagnosis, 55% had astrocytoma, and 76% had prior radiotherapy). Eighty-two percent of GMT (adequate), 100% of texting (adequate), and for ReMind 33% of retraining and 50% of compensation (inadequate) completed ≥80% of the protocol. GMT (mean: 6.75/7) and ReMind (mean: 4.5/5) satisfaction were adequate, and texting (mean: 4.5/7) was inadequate. Working memory improved from T1-to-T2 (P = .02, η² = 0.32) in 26% of the GMT group.

GMT demonstrates adequate feasibility, satisfaction, and may yield improvements in working memory, while texting and ReMind had challenges in acceptability or feasibility. Individual (tele) GMT warrants further investigation in LrGG.